Provider Demographics
NPI:1144369877
Name:COLEMAN, TARA DANIELLE (MA, OTRL, CAPS)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:DANIELLE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MA, OTRL, CAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 FRONT ST UNIT 23
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1439
Mailing Address - Country:US
Mailing Address - Phone:619-247-0777
Mailing Address - Fax:
Practice Address - Street 1:737 PEARL ST
Practice Address - Street 2:SUITE 108
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0056
Practice Address - Country:US
Practice Address - Phone:858-456-2114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist